Provider Demographics
NPI:1518372598
Name:ADAMS, LAURA (DDS)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:ADAMS
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1810 E 10TH ST
Mailing Address - Street 2:
Mailing Address - City:ROLLA
Mailing Address - State:MO
Mailing Address - Zip Code:65401-4603
Mailing Address - Country:US
Mailing Address - Phone:573-364-1821
Mailing Address - Fax:573-426-2552
Practice Address - Street 1:1810 E 10TH ST
Practice Address - Street 2:
Practice Address - City:ROLLA
Practice Address - State:MO
Practice Address - Zip Code:65401-4603
Practice Address - Country:US
Practice Address - Phone:573-364-1821
Practice Address - Fax:573-426-2552
Is Sole Proprietor?:No
Enumeration Date:2014-06-27
Last Update Date:2014-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2014018839122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist